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1.
Orthopade ; 50(2): 96-103, 2021 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-33337505

RESUMO

Mini implants are increasingly used in foot and ankle surgery. They preserve the joints' functions, are easy to insert and easy to convert to an alternative treatment. Early surgical attempts using silastic implants did not bring the expected success. First achievements where reached with modern metallic mini implants in the first metatarsophalangeal (MTP) joint and the ankle joint. For a few years now, a polyvinyl alcohol implant has been used to treat the arthritic first MTP joint. Even severe arthritic joints can be treated with an implant made of polylactide. This implant can also be used in the treatment of Lisfranc joint pathologies. To address severe osteochondral defects of the talus, an innovative hemiarthroplasty implant has been suggested. This article gives a summary of currently used mini implants. Their application as possible alternatives to total joint replacement or joint fusion are critically reviewed in the light of the current literature.


Assuntos
Artroplastia de Substituição , Hemiartroplastia , Articulação Metatarsofalângica , Tornozelo , Articulação do Tornozelo/diagnóstico por imagem , Articulação do Tornozelo/cirurgia , Artrodese , Humanos , Articulação Metatarsofalângica/cirurgia
2.
Clin Imaging ; 69: 341-348, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33059186

RESUMO

OBJECTIVES: To evaluate the diagnostic accuracy of DECT in the identification of BME of the ankle in non-traumatic patients. METHODS: This prospective institutional review board approved study included 40 consecutive patients (21 males and 19 females, mean age 56.8 years, SD = 11.37) that were examined using DECT and MRI in the period between April 2019 and January 2020. Two radiologists (7 and 16 years of experience) evaluated the presence of BME on DECT mages. Diagnostic accuracy values for diagnosing BME on a per-patient and on a per-partition basis analysis were calculated for DECT images by two readers (R1 and R2, with 16 and 7 years of experience, respectively), using MRI as a gold-standard for diagnosis. Inter-observer agreements were calculated with k-statistics. A p-value of <0.05 was considered as statistically significant. RESULTS: MRI depicted BME in 29/40 patients (72.50%) and in 43/240 partitions (17.91%). The consensus reading by R1 and R2 of DECT images allowed us to achieve 89.7% sensitivity (26/29 patients) and 81.8% specificity (9/11 patients). Regarding the partitions-basis analysis, BME was depicted by DECT in 39/43 partitions (90.69% sensitivity), and ruled out in 189/197 partitions (95.93% specificity). Sensitivity and specificity for the most involved partitions (talar dome) were both 95%. The inter-observer agreement for patients' analysis was substantial (k = 0.697), whereas for the partitions' analysis, it ranged from substantial (k = 0.724) to near perfect (k = 0.950). CONCLUSIONS: DECT can accurately diagnose BME of the ankle in a cohort of non-traumatic patients.


Assuntos
Articulação do Tornozelo , Medula Óssea , Articulação do Tornozelo/diagnóstico por imagem , Edema , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios X
3.
Bone Joint J ; 103-B(1): 87-97, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33380206

RESUMO

AIMS: Patients with a deformity of the hindfoot present a particular challenge when performing total knee arthroplasty (TKA). The literature contains little information about the relationship between TKA and hindfoot alignment. This systematic review aimed to determine from both clinical and radiological studies whether TKA would alter a preoperative hindfoot deformity and whether the outcome of TKA is affected by the presence of a postoperative hindfoot deformity. METHODS: A systematic literature search was performed in the databases PubMed, EMBASE, Cochrane Library, and Web of Science. Search terms consisted of "total knee arthroplasty/replacement" combined with "hindfoot/ankle alignment". Inclusion criteria were all English language studies analyzing the association between TKA and the alignment of the hindfoot, including the clinical or radiological outcomes. Exclusion criteria consisted of TKA performed with a concomitant extra-articular osteotomy and case reports or expert opinions. An assessment of quality was conducted using the modified Methodological Index for Non-Randomized Studies (MINORS). The review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines and registered in the PROSPERO database (CRD42019106980). RESULTS: A total of 17 studies were found to be eligible for review. They included six prospective and ten retrospective studies, and one case-control study. The effects of TKA showed a clinical improvement in the hindfoot deformity in three studies, but did not if there was osteoarthritis (OA) of the ankle (one study) or a persistent deformity of the knee (one study). The radiological alignment of the hindfoot corrected in 11 studies, but did not in the presence of a rigid hindfoot varus deformity (in two studies). The effects of a hindfoot deformity on TKA included a clinical association with instability of the knee in one study, and a shift in the radiological weightbearing axis in two studies. The mean MINORS score was 9.4 out of 16 (7 to 12). CONCLUSION: TKA improves both the function and alignment of the hindfoot in patients with a preoperative deformity of the hindfoot. This may not apply if there is a persistent deformity of the knee, a rigid hindfoot varus deformity, or OA of the ankle. Moreover, a persistent deformity of the hindfoot may adversely affect the stability and longevity of a TKA. These findings should be interpreted with caution due to the moderate methodological quality of the studies which were included. Therefore, further prospective studies are needed in order to determine at which stage correction of a hindfoot deformity is required to optimize the outcome of a TKA. Cite this article: Bone Joint J 2021;103-B(1):87-97.


Assuntos
Articulação do Tornozelo/anormalidades , Articulação do Tornozelo/diagnóstico por imagem , Artroplastia do Joelho , Mau Alinhamento Ósseo/diagnóstico por imagem , Fenômenos Biomecânicos , Humanos
4.
Medicine (Baltimore) ; 99(52): e23921, 2020 Dec 24.
Artigo em Inglês | MEDLINE | ID: mdl-33350796

RESUMO

ABSTRACT: To analyze the efficacy of arthrodesis with Ilizarov external fixator for the treatment of end-stage ankle osteoarthritis.This retrospective study included 88 patients with end-stage (stage-3) ankle osteoarthritis according to Morrey-Wiedeman classification who underwent arthrodesis with Ilizarov external fixator from January 2016 to January 2019. There were 47 males and 41 females with a mean age of (57.21 ±â€Š7.12) years old (range 49-76). Outcomes were measured by the American Orthopaedic Foot and Ankle society (AOFAS) Ankle Hindfoot Scale, Visual Analog Scale (VAS) pain scores, complications, subjective satisfaction, ankle function, correction of deformity, and complications.With an average follow-up of (13.50 ±â€Š5.41) months (range 10-21), all 88 patients returned for final follow-up. All patients achieved bony healing with a success rate of 100%. Mean postoperative healing time (3.56 ±â€Š1.04) months (range 3-6). Two patients developed sinus tract infection, delayed healing in 1 patient, and 2 patients had pain and swelling again in the ankle joint. No serious complications occurred in other patients. All the patients evaluated with the VAS scores and AOFAS scores at final follow-up showed significant improvement (P < .05). Through imaging analysis, medical tibial talar angle (MTTA) improved from (85.76 ±â€Š6.01) degrees to (88.98 ±â€Š1.35) degrees postoperative. Lateral talar station (LTS) decreased from (5.32 ±â€Š3.81) mm to (2.71 ±â€Š2.62) mm after operation (P < .05). The overall satisfaction of patients is 88.64%.In the treatment of end-stage ankle osteoarthritis, arthrodesis with Ilizarov external fixator can achieve good radiological and clinical outcomes with low prevalence of ankle joint malalignment and high fusion rates and satisfaction.


Assuntos
Articulação do Tornozelo , Artrodese , Osteoartrite , Complicações Pós-Operatórias , Articulação do Tornozelo/diagnóstico por imagem , Articulação do Tornozelo/patologia , Articulação do Tornozelo/cirurgia , Artrodese/efeitos adversos , Artrodese/instrumentação , Artrodese/métodos , China/epidemiologia , Progressão da Doença , Fixadores Externos , Feminino , Humanos , Técnica de Ilizarov , Masculino , Pessoa de Meia-Idade , Osteoartrite/diagnóstico , Osteoartrite/fisiopatologia , Osteoartrite/cirurgia , Avaliação de Resultados em Cuidados de Saúde , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Radiografia/métodos , Estudos Retrospectivos
5.
BMJ Case Rep ; 13(12)2020 Dec 22.
Artigo em Inglês | MEDLINE | ID: mdl-33370985

RESUMO

Osteochondroma of the talus is a rare entity that can cause pain, swelling, restriction of movements, synovitis and tarsal tunnel syndrome (TTS). We present three such cases with varying presentation. Case 1 presented with synovitis of the ankle along with a bifocal origin of the talar osteochondroma. Case 2 presented with TTS as a result of compression of the posterior tibial nerve. Case 3 presented with deformity of the foot. In all the three cases, the mass was excised en bloc and histologically proven to be osteochondroma. In case 3, the ankle joint was reconstructed with plate, bone graft and arthrodesis of the inferior tibiofibular joint. All the three cases had good clinical outcomes.


Assuntos
Neoplasias Ósseas/diagnóstico , Deformidades Adquiridas do Pé/etiologia , Osteocondroma/diagnóstico , Sinovite/etiologia , Tálus/patologia , Síndrome do Túnel do Tarso/etiologia , Adolescente , Adulto , Articulação do Tornozelo/diagnóstico por imagem , Articulação do Tornozelo/patologia , Articulação do Tornozelo/cirurgia , Artrodese/instrumentação , Neoplasias Ósseas/complicações , Neoplasias Ósseas/patologia , Neoplasias Ósseas/cirurgia , Placas Ósseas , Transplante Ósseo , Criança , Feminino , Deformidades Adquiridas do Pé/cirurgia , Humanos , Masculino , Osteocondroma/complicações , Osteocondroma/patologia , Osteocondroma/cirurgia , Osteotomia , Sinovite/patologia , Sinovite/cirurgia , Tálus/diagnóstico por imagem , Tálus/cirurgia , Síndrome do Túnel do Tarso/cirurgia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
6.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(11): 1387-1391, 2020 Nov 15.
Artigo em Chinês | MEDLINE | ID: mdl-33191695

RESUMO

Objective: To explore the necessity of repairing the deep layer of deltoid ligament in the treatment of mixed medial injury associated with ankle fractures. Methods: Between January 2016 and December 2018, 12 patients with mixed medial injury associated with ankle fractures were treated with the fixation of the lateral malleolus by bone plates, the fixation of the anterior colliculus of medial malleolus by cannulated screws, and the repair of the deltoid ligament by suture anchors. There were 8 males and 4 females, with an average age of 42 years (range, 18-56 years). According to the Lauge-Hansen classification criteria, there were 11 cases of supination-external rotation type and 1 case of pronation-external rotation type. According to the Weber classification criteria, all cases were type B. The time from injury to operation was 3-6 days, with an average of 4.7 days. In each patient, X-ray films of anteroposterior and lateral views and mortise view of ankle were taken postoperatively. The motion range of ankle joints was observed. The function of the ankle and the outcome of the treatment were evaluated according to the American Orthopaedic Foot and Ankle Society (AOFAS) scoring system, Olerud-Molander scoring system, and the visual analogue scale (VAS) score. Results: All cases were followed up 12-42 months (mean, 28 months). The 12 patients returned to their pre-injury jobs. Five patients with sports injury completely recovered to their pre-injury motor function. No patient experienced persistent medial ankle pain or ankle instability. At last follow-up, the ankle range of motion in dorsiflexion was 9°-25° (mean, 17.96°), which was 0°-11° (mean, 4.02°) less than that in normal side; the range of motion in plantar flexion was 38°-50° (mean, 43.90°), which was 0°-7° (mean, 2.53°) less than that in normal side. The AOFAS score was 88-100 (mean, 96.7); the Olerud-Molander score was 90-100 (mean, 96.5); the VAS score was 0-3 (mean, 1.1). Conclusion: It is necessary to repair the deep layer of deltoid ligament in the mixed medial injuries associated with ankle fracture, which include anterior colliculus fracture and deep deltoid ligament injury. A better outcome can be achieved by employing the suture anchor repair method.


Assuntos
Fraturas do Tornozelo , Traumatismos do Tornozelo , Adolescente , Adulto , Fraturas do Tornozelo/diagnóstico por imagem , Fraturas do Tornozelo/cirurgia , Traumatismos do Tornozelo/diagnóstico por imagem , Traumatismos do Tornozelo/cirurgia , Articulação do Tornozelo/diagnóstico por imagem , Articulação do Tornozelo/cirurgia , Feminino , Fixação Interna de Fraturas , Humanos , Ligamentos , Masculino , Pessoa de Meia-Idade , Âncoras de Sutura , Resultado do Tratamento , Adulto Jovem
7.
Praxis (Bern 1994) ; 109(13): 1074-1084, 2020.
Artigo em Alemão | MEDLINE | ID: mdl-33050813

RESUMO

Ultrasound of the Foot (Adapted According to SGUM Guidelines) Abstract. This review paper explains the simplified ultrasound anatomy of the foot including the ankle, midfoot and the toes. The adapted basic standard planes are described in detail according to SGUM guidelines and illustrated with a selection of high-resolution ultrasound images. A profound knowledge of the sonographic anatomy is essential for the detection of pathologies.


Assuntos
Articulação do Tornozelo , , Articulação do Tornozelo/anatomia & histologia , Articulação do Tornozelo/diagnóstico por imagem , Pé/anatomia & histologia , Pé/diagnóstico por imagem , Humanos , Ultrassonografia
8.
Orthopade ; 49(11): 991-999, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33104862

RESUMO

Concomitant valgus deformities of the ankle joint are found in approximately 3% of patients with symptomatic flat foot deformities. Conservative treatment is mostly successful only in the short term or in low-demand patients. The operative treatment of flat foot deformities follows the standard algorithm for flat foot treatment. The ankle joint can be treated while retaining mobility or by arthrodesis depending on the degree and rigidity of the deformity, degenerative changes, patient factors and expectations. Achieving an orthograde hindfoot and midfoot is obligatory for successful treatment as well as in ankle reconstructive or arthrodesis procedures.


Assuntos
Articulação do Tornozelo/cirurgia , Artrodese/métodos , Artroplastia de Substituição do Tornozelo , Pé Chato/cirurgia , Articulação do Tornozelo/diagnóstico por imagem , , Humanos
9.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(10): 1346-1351, 2020 Oct 15.
Artigo em Chinês | MEDLINE | ID: mdl-33063503

RESUMO

Objective: To review the research progress in the diagnosis and treatment of distal tibiofibular syndesmosis injury. Methods: The recent literature about distal tibiofibular syndesmosis injury was reviewed and analyzed. Results: Distal tibiofibular syndesmosis injury is commonly seen in ankle joint injury, the anatomical complexities make diagnosis and treatment difficult. Preoperative physical examination, radiologic evaluation, and intraoperative stress-testing are important for the diagnosis. Aggressive treatment is also recommended for these injuries to prevent long-term chronic instability. Internal fixation is the main treatment, including metal screw, degradable screw, elastic fixation, and hybrid techniques. Metal screw fixation is still the current mainstream, but elastic fixation represented by Suture-button is more in line with the physiological characteristics of ankle joint, and the rate of secondary operation is low while the clinical outcome is satisfactory. The application prospect of elastic fixation is worthy of expectation. Conclusion: It's crucial for patient with ankle fracture to repair the distal tibiofibular syndesmosis injury. How to diagnose the injury more accurately and simply, how to increase the success rate of reduction, and how to reduce the complications of surgery are still worthy for further exploration.


Assuntos
Traumatismos do Tornozelo , Fraturas Ósseas , Traumatismos do Tornozelo/diagnóstico , Traumatismos do Tornozelo/diagnóstico por imagem , Traumatismos do Tornozelo/cirurgia , Articulação do Tornozelo/diagnóstico por imagem , Articulação do Tornozelo/cirurgia , Parafusos Ósseos , Fixação Interna de Fraturas , Humanos
10.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 4819-4822, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33019069

RESUMO

Appropriate regulation of joint impedance is required to successfully navigate our environment. Joint impedance is strongly dependent upon the mechanical properties of the muscles and tendons spanning it. While the impedance of the joint has been well characterized, methods to determine the individual contribution from the muscles and tendons are limited. This is a crucial gap as muscle and tendon impedance can be selectively altered by aging, pathology, or injury. Therefore, we developed an innovative in vivo method that allows for the simultaneous quantification of joint, muscle, and tendon impedance. Stochastic perturbations of ankle angle were applied while a B-mode ultrasound was used to image the displacement of the medial gastrocnemius muscle-tendon junction. Non-parametric system identification was used to quantify ankle impedance and the frequency response function between ankle rotations and muscle-tendon junction displacements. The latter represents, when scaled by Achilles tendon moment arm, the ratio between the net musculotendon impedance and the impedance of the muscle, a relationship we refer to as the impedance ratio. Muscle and tendon impedance can be calculated from these experimental estimates. The ability to simultaneously quantify joint, muscle, and tendon impedance will provide a clearer understanding their respective roles in our ability to navigate our environment, and how changes in those roles may contribute to functional impairments.


Assuntos
Tendão do Calcâneo , Tornozelo , Tendão do Calcâneo/diagnóstico por imagem , Articulação do Tornozelo/diagnóstico por imagem , Impedância Elétrica , Músculo Esquelético
11.
Medicine (Baltimore) ; 99(39): e22330, 2020 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-32991444

RESUMO

RATIONALE: Widely applied in the treatment of severe ankle arthritis (AA), ankle distraction arthroplasty (ADA) can avoid not only the ankle range of motion loss but also ankle fusion. However, the clinical outcomes of ADA for severe AA are poorly understood. This study aims to present our clinical outcomes of severe AA treated by ADA. PATIENT CONCERNS: A 53-year-old man suffered right ankle sprain 10 years ago, endured right ankle pain and limited movement for 6 years. DIAGNOSIS: The patient was diagnosed as severe AA. INTERVENTIONS: He received ankle distraction arthroplasty. No adjuvant procedures were performed. The visual analog scale (VAS), the American Orthopaedic Foot and Ankle Society (AOFAS) score, the short-form (SF)-36 physical component summary (PCS) score and ankle activity score (AAS) were recorded to access the clinical outcomes pre- and postoperatively. Moreover, ankle joint space distance was evaluated on weight-bearing radiographs. OUTCOMES: The patient derived effective pain relief and restored a satisfactory range of movement. There was a 13-month follow-up period after frame removal. The AOFAS score improved from 56 preoperatively to 71 postoperatively. The VAS score decreased from 6 prior to surgery to 1 after surgery. The SF-36 PCS was 47.2 and 71.8 pre- and postoperative, respectively. The AAS scores were improved from 3.4 preoperatively to 7.3 postoperatively. LESSONS: ADA is reliable to achieve pain relief, functional recovery, and serve AA resolution. Besides, it is an alternative to ankle arthrodesis or total ankle arthroplasty in selected patients with severe AA.


Assuntos
Traumatismos do Tornozelo/complicações , Articulação do Tornozelo/patologia , Artrite/cirurgia , Osteogênese por Distração/efeitos adversos , Assistência ao Convalescente , Traumatismos do Tornozelo/fisiopatologia , Articulação do Tornozelo/diagnóstico por imagem , Artroplastia/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Osteogênese por Distração/instrumentação , Radiografia/métodos , Amplitude de Movimento Articular , Recuperação de Função Fisiológica , Índice de Gravidade de Doença , Resultado do Tratamento , Escala Visual Analógica , Suporte de Carga
12.
Acta Chir Orthop Traumatol Cech ; 87(4): 225-236, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32940217

RESUMO

Ankle arthrodesis continues to be the golden standard in the treatment of end-stage ankle arthritis. Meticulous soft tissue handling, correct positioning of the foot, and stable fixation are crucial for obtaining a favorable result. With current techniques, mostly internal fixation with screws or plates, union rates between 87 and 100% are reported. Adjacent joint arthritis remains a concern in long-term follow-up, but does not always become symptomatic. It is pre-existing in a substantial number of cases and associated with fusion in less than optimal position, particularly equinus. With arthroscopic arthrodesis techniques, wound complications and scarring can be further reduced while obtaining similar fusion rates and equivalent, if not better, functional results when compared with open techniques. Key words: ankle, hindfoot, fusion, screws, plate, anterior approach, transfibular.


Assuntos
Tornozelo , Artrite , Articulação do Tornozelo/diagnóstico por imagem , Articulação do Tornozelo/cirurgia , Artrite/cirurgia , Artrodese , Placas Ósseas , Humanos
13.
J Biol Regul Homeost Agents ; 34(3 Suppl. 2): 23-32, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32856436

RESUMO

Over the last years, an increased number of studies have reported the use of cone beam weightbearing computed tomography (WBCT) in the assessment of foot and ankle pathology. This new technology has enabled to overcome the limits inherently related to two-dimensional radiographs (superimposition bias, operator-related bias, rotation bias) and to obtain images reproducing the bones and joints anatomy during physiological standing with a low radiation dose. We performed a review of the current literature to summarize the evidence about the use of 2D or 3D measurements on WBCT images in various foot and ankle conditions. Our aims were to describe measurements proposed so far and to report data on reliability and validity from primary authors.


Assuntos
Tornozelo , Tomografia Computadorizada de Feixe Cônico , Tornozelo/diagnóstico por imagem , Articulação do Tornozelo/diagnóstico por imagem , Imageamento Tridimensional , Reprodutibilidade dos Testes , Suporte de Carga
14.
J Biol Regul Homeost Agents ; 34(3 Suppl. 2): 89-95, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32856446

RESUMO

The treatment of posterior malleolus fractures has radically changed over the last few years, therefore this study aims to summarize the current evidence on the usefulness of posterior approaches in the management of malleolar fractures. The main elements that suggest the use of a posterior approach to the ankle are the posterior malleolus fragment shape and size, the presence of loose bodies at the fracture site: the possibility to obtain an anatomic fixation of the fracture; the presence of a posterior ankle subluxation; the eventually osteochondral impaction of the tibial plafond and the mechanical stability of the joint. The postero-lateral approach has been widely used to treat these fractures, but the posteromedial approach should be considered in specific cases. The anatomic reduction of these fractures lead to joint stability, with a consequent lesser occurrence of post-traumatic arthritis and better functional outcomes.


Assuntos
Fraturas do Tornozelo , Ossos do Tarso , Fraturas do Tornozelo/diagnóstico por imagem , Fraturas do Tornozelo/cirurgia , Articulação do Tornozelo/diagnóstico por imagem , Articulação do Tornozelo/cirurgia , Fixação Interna de Fraturas , Humanos , Tíbia
15.
RMD Open ; 6(2)2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32763956

RESUMO

Reactive arthritis (ReA) is typically preceded by sexually transmitted disease or gastrointestinal infection. An association has also been reported with bacterial and viral respiratory infections. Herein, we report the first case of ReA after the he severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. This male patient is in his 50s who was admitted with COVID-19 pneumonia. On the second day of admission, SARS-CoV-2 PCR was positive from nasopharyngeal swab specimen. Despite starting standard dose of favipiravir, his respiratory condition deteriorated during hospitalisation. On the fourth hospital day, he developed acute respiratory distress syndrome and was intubated. On day 11, he was successfully extubated, subsequently completing a 14-day course of favipiravir. On day 21, 1 day after starting physical therapy, he developed acute bilateral arthritis in his ankles, with mild enthesitis in his right Achilles tendon, without rash, conjunctivitis, or preceding diarrhoea or urethritis. Arthrocentesis of his left ankle revealed mild inflammatory fluid without monosodium urate or calcium pyrophosphate crystals. Culture of synovial fluid was negative. Plain X-rays of his ankles and feet showed no erosive changes or enthesophytes. Tests for syphilis, HIV, anti-streptolysin O (ASO), Mycoplasma, Chlamydia pneumoniae, antinuclear antibody, rheumatoid factor, anticyclic citrullinated peptide antibody and Human Leukocyte Antigen-B27 (HLA-B27) were negative. Gonococcal and Chlamydia trachomatis urine PCR were also negative. He was diagnosed with ReA. Nonsteroidal Anti-Inflammatory Drug (NSAID)s and intra-articular corticosteroid injection resulted in moderate improvement.


Assuntos
Articulação do Tornozelo/diagnóstico por imagem , Artrite Reativa/diagnóstico , Infecções por Coronavirus/terapia , Pneumonia Viral/terapia , /terapia , Corticosteroides/uso terapêutico , Amidas/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Antivirais/uso terapêutico , Artrite Reativa/tratamento farmacológico , Artrite Reativa/etiologia , Artrocentese , Betacoronavirus , Infecções por Coronavirus/complicações , Humanos , Injeções Intra-Articulares , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/complicações , Pirazinas/uso terapêutico , Respiração Artificial , /complicações
16.
Medicine (Baltimore) ; 99(32): e21679, 2020 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-32769937

RESUMO

BACKGROUND: Syndesmotic injuries account for a significant number of ankle injuries. There is no consensus regarding the recommended method of treatment. The purpose of this study was to evaluate: METHODS:: This study was performed and reported in accordance with the Strengthening the Reporting of Observational studies in Epidemiology checklist. The records of 200 patients with ankle fractures who had undergone surgical treatment in our clinics between January 2014 and January 2018 were retrospectively investigated. This retrospective cohort study was approved by the institutional review board in the 2nd Hospital of Jilin University. The primary outcome measure was the American Orthopaedic Foot and Ankle Society ankle-hindfoot scale and the Foot Function Index. Secondary outcome measures included visual analog scale score, complications, range of movement of ankle, reoperations, and radiologic outcomes. For statistical comparison of the clinical and radiologic findings between the 2 groups, we used SPSS, version 21.0 (SPSS, Chicago, IL), statistical software. P Values of < .05 were considered statistically significant. CONCLUSION: The hypothesis was that the SB technique would achieve better functional outcomes as compared to the syndesmotic screw technique after surgery. TRIAL REGISTRATION: This study protocol was registered in Research Registry (researchregistry5793).


Assuntos
Articulação do Tornozelo/cirurgia , Procedimentos Ortopédicos/instrumentação , Procedimentos Ortopédicos/normas , Adulto , Idoso , Traumatismos do Tornozelo/diagnóstico por imagem , Traumatismos do Tornozelo/cirurgia , Articulação do Tornozelo/anormalidades , Articulação do Tornozelo/diagnóstico por imagem , Estudos de Coortes , Feminino , Seguimentos , Humanos , Imobilização/instrumentação , Imobilização/métodos , Masculino , Pessoa de Meia-Idade , Procedimentos Ortopédicos/estatística & dados numéricos , Estudos Retrospectivos , Estatísticas não Paramétricas , Resultado do Tratamento
17.
J Am Acad Orthop Surg ; 28(14): e595-e603, 2020 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-32692095

RESUMO

Weight-bearing CT (WBCT) scans of the foot and ankle have improved the understanding of deformities that are not easily identified on radiographs and are increasingly being used by orthopaedic surgeons for diagnostic and preoperative planning purposes. In contrast to standard CT scans, WBCT scans better demonstrate the true orientation of the bones and joints during loading. They have been especially useful in investigating the alignment of complex pathologies such as adult-acquired flatfoot deformity in which patients have been found to have a more valgus subtalar joint alignment than in a normal cohort and high rates of subfibular impingement. Studies using WBCT scans have also provided new insight into more common lower extremity conditions such as hallux valgus, ankle fractures, and lateral ankle instability. WBCT scans have allowed researchers to investigate pronation of the first metatarsal in patients with hallux valgus compared with normal feet, and patients with lateral ankle instability have been found to have more heel varus than healthy control subjects. Understanding the application of WBCT scans to clinical practice is becoming more important as surgeons strive for improved outcomes in the treatment of complicated foot and ankle disorders.


Assuntos
Tornozelo/diagnóstico por imagem , Tornozelo/fisiopatologia , Pé Chato/diagnóstico por imagem , Pé Chato/fisiopatologia , Pé/diagnóstico por imagem , Pé/fisiopatologia , Tomografia Computadorizada por Raios X/métodos , Suporte de Carga , Tornozelo/cirurgia , Fraturas do Tornozelo/diagnóstico por imagem , Fraturas do Tornozelo/fisiopatologia , Fraturas do Tornozelo/cirurgia , Articulação do Tornozelo/diagnóstico por imagem , Articulação do Tornozelo/fisiopatologia , Articulação do Tornozelo/cirurgia , Pé Chato/cirurgia , Pé/cirurgia , Hallux Valgus/diagnóstico por imagem , Hallux Valgus/fisiopatologia , Hallux Valgus/cirurgia , Humanos , Instabilidade Articular/diagnóstico por imagem , Instabilidade Articular/fisiopatologia , Instabilidade Articular/cirurgia , Planejamento de Assistência ao Paciente
18.
Yonsei Med J ; 61(7): 635-639, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32608208

RESUMO

Cavovarus deformity is considered an anatomical risk factor for chronic lateral ankle instability (CLAI). However, subtle deformity can be difficult to detect, and its correction is controversial. The current study aimed to evaluate clinical and radiographic outcomes of a modified Broström procedure (MBP) with additional procedures for CLAI with subtle cavovarus deformity and a positive peek-a-boo heel sign. We reviewed the records of 15 patients who underwent MBP with additional procedures for CLAI with a positive peek-a-boo heel sign between August 2009 and April 2015. Consecutive physical and radiographic examinations were performed. The visual analog scale (VAS) for pain, the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, and the Karlsson-Peterson (KP) ankle score were applied to assess clinical outcomes. Weight bearing radiographs, hindfoot alignment view, and ankle stress radiographs were also examined. The mean follow-up period was 58.5 months. Calcaneal lateral closing wedge osteotomy was performed in seven patients to correct fixed hindfoot varus, and first metatarsal dorsiflexion osteotomy was performed in 11 patients to correct plantarflexion of the first ray. Three patients underwent both procedures. Mean VAS, AOFAS, and KP ankle scores improved significantly (p=0.001), and instability did not recur. Radiographically, all stress parameters improved significantly (p=0.007). Simultaneous correction of a positive peek-a-boo heel sign and cavovarus deformity with MBP for CLAI improves clinical outcomes and prevents recurrent instability. A comprehensive evaluation and cautious approach for subtle cavovarus deformity should be followed when treating patients with CLAI. This trial is registered on Clinical Research Information Service (CRiS, KCT0003287).


Assuntos
Articulação do Tornozelo/cirurgia , Instabilidade Articular/cirurgia , Osteotomia/métodos , Adulto , Tornozelo/diagnóstico por imagem , Tornozelo/fisiopatologia , Articulação do Tornozelo/diagnóstico por imagem , Feminino , , Calcanhar/diagnóstico por imagem , Calcanhar/fisiopatologia , Humanos , Instabilidade Articular/diagnóstico , Instabilidade Articular/diagnóstico por imagem , Masculino , Ossos do Metatarso , Metatarso/diagnóstico por imagem , Metatarso/cirurgia , Pessoa de Meia-Idade , Radiografia , Procedimentos Cirúrgicos Reconstrutivos , Recuperação de Função Fisiológica , Pé Cavo/diagnóstico por imagem , Pé Cavo/cirurgia , Resultado do Tratamento , Escala Visual Analógica
19.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(6): 730-736, 2020 Jun 15.
Artigo em Chinês | MEDLINE | ID: mdl-32538564

RESUMO

Objective: To investigate the safety, feasibility, and efficacy of full repair strategy under small incision in the treatment of closed Lauge-Hansen pronation-external rotation type Ⅳ ankle fracture. Methods: The clinical data of 57 patients with closed Lauge-Hansen pronation-external rotation type Ⅳ ankle fracture treated by full repair strategy (fracture, ligament, and cartilage repair) under small incision between January 2012 and January 2017 were retrospectively analyzed. There were 31 males and 26 females, with an average age of 41.1 years (range, 21-65 years). The causes of injury included traffic accident injury in 33 cases and falling injury in 24 cases. All of them were closed fractures, including 20 cases of medial malleolus fracture, 37 cases of complete medial malleolus but deep and shallow rupture of deltoid ligament. The average time from injury to admission was 9.6 hours (range, 3-34 hours). The quality of reduction of distal tibial articular surface (based on Ketz-Sanders standard), the reduction of tibiofibular syndesmosis (the anterior and posterior distances of distal tibiofibular syndesmosis and the lateral ankle twist angle measured by CT scan at 10 mm above the ankle joint line), and the fracture healing were evaluated. The medial clear space (MCS), tibiofibular clear space (TFCS), and distal fibular tip to lateral process of talus (DFTL) were measured on the X-ray films of ankle points. Before and after operation, the pain and functional improvement of ankle joint were evaluated by visual analogue scale (VAS) score and American Orthopedic Foot and Ankle Association (AOFAS) score, and the activities of ankle dorsiflexion and plantar flexion were measured. Results: Three cases with osteochondral lesions of the talus were found during operation and all were treated with microfracture techniques. Tournament paralysis occurred in 2 cases after anesthesia. The surgical incisions healed by first intention in all patients. All the 57 patients were followed up 24-84 months, with an average of 38.6 months. All patients achieved bone healing without bone nonunion and malunion at 12 months after operation. The reduction quality of distal tibial articular surface was excellent in 56 cases and good in 1 case at 3 months after operation, the excellent and good rate was 100%. There was no significant difference in the MCS, TFCS, DFTL, anterior distance of distal tibiofibular syndesmosis, posterior distance of distal tibiofibular syndesmosis, and lateral ankle twist angle between the affected and healthy sides at 12 months after operation ( P>0.05). At last follow-up, the VAS score, AOFAS score, ankle dorsiflexion and plantar flexion activities of the affected side were significantly improved when compared with preoperative ones ( P<0.05). Compared with the healthy side, there was no significant difference in ankle dorsiflexion and plantar flexion activities ( P>0.05). Conclusion: Full-repair strategy under small incisions for the treatment of Lauge-Hansen pronation-external rotation type Ⅳ ankle fracture is effective and safe. It can not only reduce wound complications, but also improve the quality of joint reduction of the ankle joint and distal tibiofibular syndesmosis. Full repair of ligaments and cartilage can improve the internal fixation strength and joint stability of the ankle joint.


Assuntos
Fraturas do Tornozelo , Ferida Cirúrgica , Adulto , Idoso , Fraturas do Tornozelo/diagnóstico por imagem , Fraturas do Tornozelo/cirurgia , Articulação do Tornozelo/diagnóstico por imagem , Articulação do Tornozelo/cirurgia , Feminino , Fixação Interna de Fraturas , Humanos , Masculino , Pessoa de Meia-Idade , Pronação , Estudos Retrospectivos , Rotação , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Adulto Jovem
20.
Jt Dis Relat Surg ; 31(2): 372-376, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32584739

RESUMO

The varus ankle deformity can lead to osteoarthritis; therefore, numerous supramalleolar tibia osteotomy techniques are described to correct this deformity. Many of these techniques are more suitable for uniplanar ankle deformity. Particularly, if there are multiplane ankle deformities, the use of the six-axis deformity correction system may be successful in solving the problems which may occur during the correction. In this article, we report two cases of three plane deformities of ankle joint due to trauma sequelae, which were treated with supramalleolar osteotomy using a hexapod fixator which is called the Smart Correction Frame®.


Assuntos
Articulação do Tornozelo , Fixadores Externos , Deformidades Adquiridas do Pé , Osteoartrite/prevenção & controle , Osteotomia , Adolescente , Adulto , Traumatismos do Tornozelo/complicações , Articulação do Tornozelo/diagnóstico por imagem , Articulação do Tornozelo/patologia , Articulação do Tornozelo/cirurgia , Desenho Assistido por Computador , Feminino , Deformidades Adquiridas do Pé/complicações , Deformidades Adquiridas do Pé/fisiopatologia , Deformidades Adquiridas do Pé/cirurgia , Humanos , Masculino , Osteoartrite/etiologia , Osteotomia/instrumentação , Osteotomia/métodos , Radiografia/métodos , Recuperação de Função Fisiológica , Resultado do Tratamento
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